What to check when soreness is felt away from its cause

What to check when knee soreness may begin at the hip

Hip trouble may ache across the buttock, thigh, groin, or front of the knee. That’s why a knee exam sometimes includes moving the hip and checking your back while you sit and stand.

Notice whether putting on a shoe or rising from a low chair brings soreness. Don’t force those motions; simply tell the doctor what happens during your normal day.

What to check when shoulder soreness reaches the arm

A sore shoulder can send aching into the upper arm without involving the neck. Reaching overhead may bring shoulder soreness, while turning your neck may suggest a neck nerve is involved.

Numb fingers or a true loss of strength need a prompt doctor visit, unlike moving less because it hurts. Write down where numbness starts, because the doctor needs to check the whole area.

What to bring when a scan does not match

Scans often show wear or small tears in older joints that aren’t causing soreness. Wear or a tear matters more when it agrees with your sore spot and the hands-on exam.

Bring the report, plus short notes on movement, rest, swelling, sleep, and recent falls. Ask whether the scan changes your care, and don’t let one medical word decide everything.

What to report when several joints hurt

Several sore joints need more than a check of each painful spot. The body may be reacting to illness, medicine, poor sleep, or arthritis.

Tell your doctor when the aches began and whether fever, rash, or swelling came first. Recent travel and illness also matter, even when the soreness began after you returned.

Sources

1. In 51 consecutive patients whose hip joint was confirmed as the pain source by fluoroscopically guided intra-articular injection, the pain was NOT where the textbook says. Buttock pain was the commonest referral area (71%), ahead of the traditionally taught thigh (57%) and groin (55%); 22% had pain radiating below the knee and 6% into the foot. Fourteen distinct referral patterns were observed, and referral into the lower lumbar spine did not occur.

   Lesher JM, Dreyfuss P, Hager N, Kaplan M, Furman M — Hip joint pain referral patterns: a descriptive study.. Pain Medicine, 2008. DOI: 10.1111/j.1526-4637.2006.00153.x.

2. In 113 patients with end-stage hip disease undergoing hip replacement (patients with coexisting knee or spine pathology excluded), the commonest pain sites before surgery were groin, anterior thigh, buttock, ANTERIOR KNEE and greater trochanter. Pain was also recorded in areas not normally considered hip referral zones: lower back in 21.2%, shin in 7.1% and calf in 2.7%. Low back pain was significantly more common in patients with longer symptom duration. Regardless of pattern, 97.3% reported complete pain relief within 12 weeks of hip replacement.

   Hsieh PH, Chang Y, Chen DW, Lee MS, Shih HN, Ueng SWN — Pain distribution and response to total hip arthroplasty: a prospective observational study in 113 patients with end-stage hip disease.. Journal of Orthopaedic Science, 2012. DOI: 10.1007/s00776-012-0204-1.

3. A monograph on the musculoskeletal conditions that imitate cervical radiculopathy lists nine categories that can send pain into the shoulder or arm without any nerve root being involved: neck tension and cervicogenic headache, temporomandibular disorder, referred pain from rotator cuff pathology, medial and lateral epicondylitis, De Quervain's tenosynovitis and intersection syndrome, myofascial trigger points, frozen shoulder and tight pectoral or scalene muscles, post-stroke shoulder subluxation, thoracic outlet syndrome, and complex regional pain syndrome.

   Chiou-Tan FY — Musculoskeletal mimics of cervical radiculopathy.. Muscle & Nerve, 2022. DOI: 10.1002/mus.27553.

4. Fifty-one men aged 40-70 with no symptoms in either shoulder had one shoulder scanned by ultrasound to a defined protocol. Abnormalities were found in 96% of them: subacromial-subdeltoid bursal thickening in 78%, acromioclavicular joint osteoarthritis in 65%, supraspinatus tendinosis in 39%, subscapularis tendinosis in 25%, a partial-thickness bursal-side supraspinatus tear in 22% and a posterior labral abnormality in 14%.

   Girish G, Lobo LG, Jacobson JA, Morag Y, Miller B, Jamadar DA — Ultrasound of the shoulder: asymptomatic findings in men.. American Journal of Roentgenology, 2011. DOI: 10.2214/AJR.11.6971.

5. A systematic review and meta-analysis of 316 articles on chikungunya found arthralgia in 90% of cases during the acute phase (95% CI 83-94%) and fever in 88% (85-90%). Applying broader inclusion criteria, the overall symptomatic rate was 75% (63-84%) and the CHRONICITY rate - symptoms persisting beyond the acute phase - was 44% (31-57%). Mortality was 0.3%.

   Rama K, de Roo AM, Louwsma T, et al. — Clinical outcomes of chikungunya: A systematic literature review and meta-analysis.. PLoS Neglected Tropical Diseases, 2024. DOI: 10.1371/journal.pntd.0012254.

6. Lyme disease is the most common vector-borne illness in North America and Europe, caused by Borrelia burgdorferi sensu lato and transmitted by Ixodes ticks across temperate regions of the northern hemisphere. Clinical features are diverse but death is rare, infection rates are highest in children aged 5-15 and adults over 50, and in the north-eastern United States - where the disease is most common - exposure occurs primarily in the area immediately around the home.

   Mead P — Epidemiology of Lyme Disease.. Infectious Disease Clinics of North America, 2022. DOI: 10.1016/j.idc.2022.03.004.

7. In the Framingham Osteoarthritis Study, 710 people over 50 with NO radiographic evidence of knee osteoarthritis underwent knee MRI: 89% had 'any abnormality'. Osteophytes appeared in 74%, cartilage damage in 69% and bone marrow lesions in 52%. Prevalence of at least one abnormality was 90-97% in painful knees and 86-88% in painLESS knees.

   Guermazi A, et al. — Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study).. BMJ, 2012. DOI: 10.1136/bmj.e5339.